Lockable intramedullary fixation device

ABSTRACT

An orthopedic device can include an intramedullary nail with a longitudinal bore, first and second bone fasteners with sleeves and a cannulated movable member received within the longitudinal bore. The movable member defines first and second guiding bores for receiving respectively the first and second fasteners. Each of the first and second guiding bores includes a pair of opposing deformable elongated strips. Each pair of strips can engage the sleeve of a corresponding bone fastener.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 11/627,575 filed on Jan. 26, 2007.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/117,765 filed on May 9, 2008.

The disclosures of the above applications are incorporated herein byreference.

INTRODUCTION

Different nailing systems and associated instruments are known for thefixation of fractures of the femur, such as shaft fractures,subtrochanteric fractures, intertrochanteric fractures, neck fracturesand combinations thereof, as well as for reconstruction of the femurfollowing tumor resection or other surgery.

The present teachings provide for versatile and effective internalfixation devices that can be used for internal fixation of long bones.

SUMMARY

The present teachings provide an orthopedic device that includes anintramedullary implant defining a longitudinal bore, and a cannulatedmovable member receivable within the longitudinal bore andtelescopically movable relative to the longitudinal bore. The movablemember defines a plurality of guiding bores for bone fasteners, and ismovable between a fastener engagement position and a fastenerdisengagement position. The guiding bores can be at an angle relative tothe longitudinal bore of the intramedullary implant.

In another aspect, the present teachings provide an orthopedic devicethat includes an intramedullary implant defining a longitudinal bore anda plurality of fastener bores inclined relative to the longitudinalbore, a plurality of bone fasteners receivable in corresponding fastenerbores, and a securing device. The securing device can movetelescopically within the longitudinal bore between a first positionthat engages at least two bone fasteners to the intramedullary implant,and a second position that disengages the two bone fasteners from to theintramedullary implant.

In yet another aspect, the present teachings provide an intramedullaryimplant defining a longitudinal bore and at least first and secondfastener bores inclined relative to the longitudinal bore. Theorthopedic device can further include at least first and second of bonefasteners receivable in the corresponding first and second fastenerbores, a movable member and a locking member. The movable member definesat least first and second guiding bores for receiving the first andsecond fasteners, and can telescopically move within the longitudinalbore between a first position that engages the first and second bonefasteners to the intramedullary implant, and a second position thatdisengages the first and second bone fasteners from to theintramedullary implant, the movable member. The locking member can havean externally threaded portion threadably engageable to a threadedportion of the longitudinal bore, and a resilient portion couplable tothe movable member.

The present teachings further provide an orthopedic device that includesan intramedullary implant defining a longitudinal bore, at least onebone fastener, and a securing device. The securing device is movablewithin the longitudinal bore between a locked position that engages theat least one bone fastener to the intramedullary implant, and anunlocked position that disengages the at least one bone fastener from tothe intramedullary implant. The securing device includes at least oneguiding bore threadably engageable or threadably disengageable with theat least one bone fastener while the securing device is in the lockedposition.

In another aspect, the present teachings provide an orthopedic deviceincluding an intramedullary implant defining a longitudinal bore, firstand second fasteners, each fastener including a threaded shaft and asubstantially cylindrical unthreaded sleeve, and a cannulated movablemember receivable within the longitudinal bore and telescopicallymovable relative to the longitudinal bore. The movable member definesfirst and second guiding bores for respectively receiving the first andsecond fasteners. Each of the first and second guiding bores is at anangle relative to the longitudinal bore. Each of the first and secondguiding bores includes a pair of opposing deformable elongated stripsengageable with the respective sleeve. The movable member can movebetween a fastener engagement position and a fastener disengagementposition.

In another aspect, the orthopedic device includes an intramedullaryimplant defining a longitudinal bore, and first and second fasteners,each of the first and second fasteners including a threaded shafttelescopically received in a corresponding substantially cylindricalunthreaded sleeve. The orthopedic device also includes a third fastenerincluding a threaded shaft, and a cannulated movable member receivablewithin the longitudinal bore and telescopically movable relative to thelongitudinal bore. The movable member defines first, second and thirdguiding bores for selectively receiving respectively the first, secondand third fasteners. The first, second and third guiding bores are atvariable angles relative to the longitudinal bore and at variable anglesrelative to one another. Each of the first and second guiding boresincludes a pair of opposing deformable elongated strips engageable withthe respective sleeve. The third guiding bore includes a threadedformation engageable with the threaded shaft of the third fastener. Themovable member moves between a fastener engagement position and afastener disengagement position.

In a further aspect, the orthopedic device includes an intramedullaryimplant defining a longitudinal bore and first, second, third and fourthbone fasteners passing at variable angles and positions through thelongitudinal bore of the intramedullary implant. The orthopedic devicealso includes a movable member defining first, second, third and fourthguiding bores for receiving the first, second, third and fourthfasteners. The movable member can move telescopically within thelongitudinal bore between a first position that engages the first,second, third and fourth bone fasteners to the intramedullary implant,and a second position that disengages the first, second, third andfourth bone fasteners from the intramedullary implant.

Further areas of applicability of the present invention will becomeapparent from the description provided hereinafter. It should beunderstood that the description and specific examples are intended forpurposes of illustration only and are not intended to limit the scope ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is an environmental view of a fixation device according to thepresent teachings, illustrating a trochanteric procedure withinterlocking fixation fasteners;

FIG. 1A is a sectional view of a proximal portion of an intramedullaryimplant of the fixation device of FIG. 1;

FIG. 2 is an enlarged view of a detail of FIG. 1;

FIG. 3 is an environmental view of a fixation device according to thepresent teachings, illustrating a trochanteric procedure withreconstruction fixation fasteners;

FIG. 4 is an enlarged view of a detail of the fixation device of FIG. 3;

FIG. 4A is a partial cut-out view of a detail of the fixation device ofFIG. 3

FIG. 5A-C are various perspective view of an insert for the fixationdevices of FIGS. 2 and 3;

FIG. 5D is a top view of the insert if FIG. 5A;

FIG. 5E is a sectional view of the insert of FIG. 5A;

FIG. 6A is a perspective view of a locking member according to thepresent teachings;

FIG. 6B is a side view of the locking member of FIG. 6A;

FIG. 6C is a sectional view of the locking member of FIG. 6A;

FIG. 7 is an environmental view of a fixation device according to thepresent teachings, illustrating a retrograde femoral procedure;

FIG. 8 is an enlarged view of a detail of FIG. 7;

FIG. 8A is a side view of an intramedullary implant of the fixationdevice of FIG. 7;

FIG. 8B is another side view of an intramedullary implant of thefixation device of FIG. 7, shown partially in section;

FIGS. 9A and 9B are perspective views of an insert for the fixationdevice of FIG. 7;

FIG. 9C is a sectional view of the insert of FIG. 9A;

FIG. 10 is an environmental view of a fixation device according to thepresent teachings, illustrating a piriformis procedure with interlockingfixation fasteners;

FIG. 11 is an enlarged view of a detail of FIG. 10;

FIG. 12 is an environmental view of a fixation device according to thepresent teachings, illustrating a piriformis procedure withreconstruction fixation fasteners;

FIG. 13 is an enlarged view of a detail of FIG. 12;

FIGS. 14A and 14B are perspective views of an insert for the fixationdevices of FIGS. 10 and 12;

FIG. 14C is a sectional view of the insert of FIG. 14A;

FIG. 15 is a partially exploded perspective view of a portion of afixation device according to the present teachings;

FIG. 16 is a perspective view illustrating an insert assembled with alocking member for an intramedullary nail according to the presentteachings;

FIG. 17A is an environmental perspective view of a fixation deviceaccording to the present teachings, illustrating a femoral procedurewith transverse fixation fasteners;

FIG. 17B is an enlarged detail of FIG. 17A;

FIG. 18A is a perspective view illustrating a first position of aninsert for an intramedullary nail according to the present teachings;

FIG. 18B is a perspective view illustrating a second position of theinsert of FIG. 18A;

FIG. 19A is a perspective view illustrating instruments for engaging anddisengaging an insert for an intramedullary implant according to thepresent teachings;

FIG. 19B is an enlarged detail of FIG. 19A;

FIG. 20 is an environmental view of a fixation device according to thepresent teachings, illustrating a piriformis procedure with anintramedullary implant and reconstructive fixation fasteners in theproximal femur;

FIG. 20A is an enlarged view of a detail of FIG. 20;

FIG. 21 is a perspective view of an insert for the intramedullaryimplant of FIG. 20;

FIG. 22 is a sectional view of the insert of FIG. 21;

FIG. 23 is an environmental view of a fixation device according to thepresent teachings, illustrating a piriformis procedure with anintramedullary implant and an interlocking fixation fastener in theproximal femur;

FIG. 24 is an environmental view of a fixation device according to thepresent teachings, illustrating a trochanteric procedure with anintramedullary implant and reconstructive fixation fasteners in theproximal femur;

FIG. 25 is an exploded view of a securing device for the intramedullaryimplant of FIG. 24;

FIGS. 26 and 27 are perspective views of the securing device of FIG. 25;

FIGS. 28 and 29 are perspective views of an insert of the securingdevice of FIG. 25;

FIG. 30 is a sectional elevated view of the insert of FIG. 28;

FIG. 31 is another perspective view of the insert of FIG. 26;

FIG. 32 an environmental view of a fixation device according to thepresent teachings, illustrating a trochanteric procedure with anintramedullary implant and an interlocking fixation fastener in theproximal femur;

FIG. 33 is an environmental view of a fixation device according to thepresent teachings, illustrating a retrograde procedure with anintramedullary implant and interlocking fixation fasteners in the distalfemur;

FIG. 33A is an enlarged detail of FIG. 33;

FIG. 34 is an exploded view of a securing device for the intramedullaryimplant of FIG. 33;

FIG. 35 is a perspective view of the securing device of FIG. 34;

FIG. 36 is a perspective view of an insert of the securing device ofFIG. 35; and

FIG. 37 is a sectional elevated view of the insert of FIG. 36.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is in no wayintended to limit the invention, its application, or uses. For example,although the present teachings are illustrated for exemplarytrochanteric, piriformis and retrograde procedures with reconstructiveor interlocking femoral fixation, and for proximal tibial fixation, thepresent teachings can be used for other fixation procedures involvinglong bones. It will be understood that general surgical procedures areoutlined only as needed to illustrate the devices and methods providedby the present teachings, while detailed descriptions of standard andknown procedures and instruments are omitted for simplicity.

Exemplary fixation devices 100 are illustrated and described below.FIGS. 1-6C illustrate fixation devices for trochanteric femoralfixation, FIGS. 7-9B for retrograde femoral fixation, FIGS. 10-14C forpiriformis femoral fixation, and FIGS. 15-19B for cortical tibialfixation. Although some of the structural details and/or sizes of thefixation components for each procedure may differ, each fixation device100 can include an intramedullary nail or implant 102, a telescopicclamp or securing device 200 that includes a hollow insert or similarmovable member 160 and a cannulated set screw or similar locking member180, and various bone fasteners, including single-piece interlockingfasteners 104 and reconstruction fasteners 140, including lag screws andtelescopic screws slidable within sleeves. The movable member 160 can becannulated and can include a plurality of openings defining guidingbores configured for guiding the orientation of corresponding bonefasteners, as is described below in reference to particular procedures.In the interest of brevity, details described with respect to oneprocedure will generally not be repeated in other procedures. Forexample, although dynamic and static engagement positions of the movablemember 160 of the telescopic clamp/securing device 200 device areillustrated with respect to tibial procedures in FIGS. 18A and 18B, itwill be understood that telescopic clamp/securing device 200 device canoperate similarly in all the other procedures.

Referring to FIGS. 1, 1A, and 2, an exemplary fixation device 100according to the present teachings is shown implanted in a femur 80 foran interlocking trochanteric procedure. The fixation device 100 caninclude an elongated intramedullary implant 102 and an elongatedinterlocking fastener 104. The intramedullary implant 102 can include ashaft 110 having proximal and distal portions 112, 114 and received inthe intramedullary canal of the femur 80. The proximal portion 112 ofthe intramedullary implant 102 can include a proximal longitudinal bore113 defining a longitudinal axis A. A proximal inner surface 111 of theproximal longitudinal bore 113 can be of elliptical or othernon-circular shape, having different major and minor diameters such thatthe cross-section has an elongated shape.

The proximal portion 112 of the intramedullary implant 102 can includefirst and second fastener bores 120, 130 along first and second axes Cand C′ at first and second angles β and β′ relative to the longitudinalaxis A, as shown in FIG. 1A. The axes C and C′ can be parallel such thatthe angles β and β′ are substantially equal. The first bore 120 can bedefined by first and second opposite-side openings 122 and 124 that canbe offset along the direction of axis A, thereby defining the first axisC at an angle β relative to the axis A. The second bore 130 can bedefined by third and fourth opposite-side openings 132 and 134 that canbe offset along the direction of axis A, such that they define thesecond axis C′ at an angle β′ relative to the axis A. The first, second,third and fourth opening 122, 124, 132, 134 can have closed perimeters.The first and fourth openings 122, 134 can define a third fastener bore136 along an axis B at an angle α relative to the longitudinal axis A,as shown in FIG. 1A.

The interlocking fastener 104 can be oriented along the axis B passingthrough fastener bore 136 of the intramedullary implant 102. Theinterlocking fastener 104 can extend from a proximal lateral positionnear the greater trochanter 82 to a more distal medial position near thelesser trochanter 84 of the femur 80, as shown in FIG. 2. Theinterlocking fastener 104 can include a head 106 and a threaded shaft108 with threads, ridges or other anchoring formations. One or morefasteners 104′, generally similar in structure to the interlockingfastener 104, can be inserted through the distal portion 114 of theintramedullary implant 102 for fixation to the distal femur.

Referring to FIGS. 1A, 3 and 4, another exemplary fixation device 100according to the present teachings is shown implanted in the femur 80for a reconstructive trochanteric procedure. Two reconstructionfasteners 140 can be oriented along the directions defined by the firstand second axes C and C′ passing through the corresponding first andsecond fastener bores 120, 130 of the intramedullary implant 102.Accordingly, the reconstruction fasteners 140 can be oriented atrespective first and second angles β and β′ relative to the longitudinalaxis A, as described above. The reconstruction fasteners 140 can extendfrom the vicinity of the greater trochanter 82 through the femoral neck88 and into the femoral head 86. Each reconstruction fastener 140 can bea two-piece telescoping component including a sleeve 144 having alongitudinal bore 150 and a lag screw 142 that can pass through the bore150 of the sleeve 144 and can slide relative to the sleeve 144. The lagscrew 142 can include an unthreaded portion 140 receivable in the bore150 of the sleeve 144, and a threaded or bone anchoring portion 146.

Referring to FIGS. 1-6C, either the interlocking fastener 104 or thereconstruction fasteners 140 can be secured to the intramedullaryimplant 102 using a securing device 200. The securing device 200 caninclude a telescopic insert or movable member 160, and a locking member180, such as a set screw. The movable member 160 can be adapted forlocking multiple fasteners to the intramedullary implant 102, as shownin FIGS. 2 and 4. The movable member 160 can include a circularlongitudinal bore 162 defining longitudinal axis “A1”. When the movablemember 160 is inserted into the longitudinal bore 113 of theintramedullary implant 102, the longitudinal axes A and A1 cansubstantially coincide. The movable member 160 can define first andsecond guiding bores 164, 166 oriented along the first and second axesC1, C1′, as shown in FIG. 5C. When the movable member 160 is insertedinto the bore 113 of the intramedullary implant 102, the first andsecond axes C, C′ of the intramedullary implant can substantiallycoincide with the first and second axes C1, C1′ of the movable member160.

The first guiding bore 162 can be fully enclosed within the movablemember 160 and defined by first and second openings 170, 172. The firstand second opening 170, 172 can be axially offset, can have closedperimeters and can be formed on opposing sides of the movable member 160along the first axis C1. The second guiding bore 166 can be partiallyenclosed and defined by a third opening 174 having an open perimeter, asshown in FIG. 5C. It will be appreciated, however, that the secondguiding bore 166 can also be fully enclosed and defined by two opposingopenings along the axis C1′ of the movable member 160. The first andsecond reconstruction fasteners 140 can be inserted through the firstand second guiding bores 164, 166 of the movable member 160 and throughthe corresponding first and second fastener bores 120, 130 of theintramedullary implant 102 along the axes C, C′, as shown in FIG. 4.

The movable member 160 can also include a third guiding bore 168 definedalong axis B1 and at an angle α relative to the longitudinal axis A1.When the movable member 160 is inserted into the longitudinal bore 113of the intramedullary implant 102, the axes B and B1 can substantiallycoincide. The guiding bore 168 can be defined by the first opening 170and an opposite-side and longitudinally offset and open-perimeter fourthopening 176. The perimeter of the opening fourth 176 can intersect theperimeter of the third opening 174, such that the fourth and thirdopenings 174, 176 can communicate, as shown in FIGS. 5A and 5C. Aninterlocking fastener 104 can be received in the third guiding bore 168passing through the third fastener bore 136 of the intramedullaryimplant 102, when reconstruction fasteners 140 are not used, as shown inFIG. 2. Ridges or other engagement formations 178 can be provided inportions of any guiding bores of the movable member 160 for engagingcorresponding threads or ridges of the threaded shaft 108 ofinterlocking fasteners 104. Ridges 178 are illustrated, for example, inFIGS. 5A-5C in connection with trochanteric femoral procedures, in FIGS.9A-9C for retrograde femoral procedures, in FIGS. 14A and 14B forpiriformis femoral procedures, and in FIGS. 16, 17B, 18A and 18C fortibial procedures. The ridges 178 allow removal or backing out of anindividual interlocking fastener 104 by rotating the head 106 ofinterlocking fastener 104 in a counterclockwise direction with a driver,for example, while the intramedullary implant 102 and the otherinterlocking fasteners 104 remain secured in place with the securingdevice 200 in a locked position. Accordingly, any interlocking fastener104 can be removed or backed out without accessing the top of theintramedullary implant 102 for disengaging the interlocking fastener104. Therefore, the procedure described below in connection with FIGS.19A and 19B for unlocking the securing device 20 need not be used forbacking out or completely removing one of the interlocking fasteners104.

Referring to FIGS. 5D and 5E, the movable member 160 can include aproximal end portion having an outer surface 161 with elliptical orelongated cross-section, and a body with a circular cylindrical surface163, as shown in FIGS. 5D and 5E. The outer surface 161 of the movablemember 160 can mate with the inner surface 111 of the proximallongitudinal bore 113 providing a keyed insertion, such that the movablemember 160 can be inserted in the proximal longitudinal bore 113 ineither one of two directions that are 180 degrees apart, as illustratedin FIG. 15 in connection with a movable member 160 and an intramedullaryimplant 102 for a tibial procedure described below. The longitudinalinner bore 162 of the movable member 160 can be circular.

Referring to FIGS. 6A-6C, various views of a locking member 180 areillustrated. The locking member 180 can include a longitudinal bore 182along a longitudinal axis A2. The locking member 180 can include athreaded portion 184 and an unthreaded cylindrical portion 185. Thethreaded portion 184 can threadably engage a threaded inner surface 115of the proximal longitudinal bore 113 of the intramedullary implant 102,as shown in FIGS. 15 and 16 in connection with a movable member 160 andintramedullary implant 102 for a tibial procedure described below. Thelocking member 180 can also include a distal flexible or resilientportion 186 defined by a plurality of legs 188 extending from theunthreaded portion 185 of the locking member 180 and separated by slots190. The resilient portion 186 can define a step or flange 192 that canbe retained into a groove 167 of the movable member 160, shown in FIG.5E, for example, when the resilient portion 186 is snap-fitted into thelongitudinal bore 162 of the movable member 160, as shown in FIGS. 15and 16.

The locking member 180 can also include a driver engagement formation194 in a proximal portion of the bore 182 for engaging a driver 500. Thedriver 500 can be rotated for threadably engaging the locking member 180with the intramedullary implant 102, such that advancement of lockingmember 180 and corresponding advancement of the movable member distallyor proximally can engage or disengage the movable member 160 fromcorresponding bone fasteners, such as fasteners 104, as shown in FIGS.19A, 19B, 18A and 18B, in connection with a tibial procedure, asdescribed in further detail below. The locking member 180 can alsoinclude holes or other openings 196 that interrupt the threads of thethreaded portion 184. The openings 196 can be plugged with thread locks198 that prevent further engaging or disengaging movement between thelocking member 180 and the intramedullary implant 102, thereby securingthe corresponding position of the movable member 160 relative to theintramedullary implant 102 and the fasteners 104 or 140. The threadlocks 198 can be made of polyethylene, for example.

Referring to FIGS. 7-9B, an exemplary fixation device 100 is illustratedfor a retrograde interlocking femoral fixation procedure. The retrogradeintramedullary implant 102 can be inserted in the distal portion of thefemur 80 in a retrograde direction and can interlock at least up tothree bone fasteners 104 using the movable member 160 and the lockingmember 180 of the securing device 200. The retrograde intramedullaryimplant 102 can define a plurality of through-bores, for example first,second and third bores 302, 302′, 302″ oriented transversely or at otherdifferent angles relative to longitudinal axis A of the retrogradeintramedullary implant 102. Some of the bores 302, 302′, 302″ cancircumferentially offset relative to the longitudinal axis A, or can bealigned along the longitudinal axis A, as shown in FIG. 8A. The movablemember 160 can include corresponding first, second and third guidingbores 304, 304′, 304″ oriented along first, second and third axes C2,C2′, and C2″, as shown in FIGS. 8 and 9A. The first and second guidingbores 304, 304′ can have closed perimeters, while the third guiding bore304″ can have an open perimeter defining a pair of opposing legs 306.Some of the first, second and third guiding bores 304, 304′, 304″ can bealigned or circumferentially offset relative to one another or relativeto the longitudinal axis A1, and can be parallel or non-parallel. Thestructure and function of the locking member 180 and other features ofthe securing device 200 and retrograde intramedullary implant 102 aresimilar to those described above in connection with trochantericprocedure illustrated in FIGS. 1-6C and are not repeated.

Referring to FIGS. 10-14B, an exemplary fixation device 100 according tothe present teachings is illustrated for piriformis femoral procedures.FIGS. 10 and 11 illustrate an interlocking piriformis fixationprocedure, and FIGS. 12 and 13 illustrate a reconstruction piriformisfixation procedure. The piriformis intramedullary implant 102, thepiriformis interlocking fastener 104 and the piriformis securing device200 are similar to the corresponding components described in connectionwith the trochanteric procedures illustrated in FIGS. 1-6C and theirdescription is not repeated, except to note different or additionalelements. The piriformis intramedullary implant 102 can be configuredfor entry through the piriformis fossa 90 near the greater trochanter82, as shown in FIG. 11. The reconstruction fasteners 140 can includesingle-piece piriformis lag screws 142 having a threaded portion 146, anunthreaded portion 148 and a head 147, as shown in FIG. 13. Thepiriformis lag screws 142 can pass through the piriformis intramedullaryimplant 102 along axes C, C′, and through the piriformis movable member160 of piriformis securing device 200 along corresponding axes C1, C1′at angles β and β′, which can be equal or different. The piriformis lagscrews 142 can be also be used with sleeves 144 in a telescopic manner,as described in connection with the trochanteric procedure illustratedin FIG. 4. Various views of the piriformis movable member 160 areillustrated in FIGS. 14A-14C using the same reference characters as usedin FIGS. 5A-5E to describe similar elements.

Referring to FIGS. 15-16, aspects of a tibial securing device 200 andits insertion into a tibial intramedullary implant 102, as discussedabove, are illustrated for tibial procedures. The tibial movable member160 can include first, second and third bores 171, 173, 175 transverselyoriented relative to the longitudinal axis A1 of the movable member 160,and circumferentially offset relative to one another, as shown in FIGS.16, 17A, and 17B. The first and second bores 171, 173 can have closedperimeters and receive corresponding interlocking fasteners 104, such ascortical screws that pass through corresponding bores of the tibialintramedullary implant 102 for fixation into the tibia 70, as shown inFIGS. 17A and 17B. The third bore 175 can have an open perimeterdefining two opposing legs 169.

Referring to FIGS. 18A and 18B, use of the securing device 200 foractive compression of fractures is illustrated. An interlocking fastener104 can pass through the third bore 175 of the movable member 160 andthrough an elongated slot 103 of the intramedullary implant 102. FIG.18A illustrates the securing device 200 in a first position that allowsdynamic movement along the slot 103. FIG. 18B illustrates the securingdevice 200 in a second position, in which the fastener 104 engages thedistal wall of the slot 103. The movable member 160 can be moved fromthe first to the second position by rotation of the locking member 180,such that the locking member 180 threadably moves relative to theintramedullary implant 102 and forces the movable member 160 to movedistally in the direction of arrow D relative to the intramedullaryimplant 102.

Referring to FIGS. 19A and 19B, a targeting device 600 forengagement/disengagement of the securing device 200 is illustrated. Thetargeting device 600 can include a radiolucent targeting arm 602, adriving handle 604 and a cannulated connecting bolt 606 that connectsthe targeting device 600 to the intramedullary implant 102. A driver 500with a flexible driving shaft 502 can pass through the bore 608 of theconnecting bolt 606 and engage the driver engagement formations 194 ofthe locking member 180. Rotating the driver shaft 502 clockwise orcounterclockwise rotates the locking member 180 correspondingly, andcorrespondingly urges the movable member 160 distally to a position ofengagement with the interlocking fasteners 104, or proximally to aposition of disengagement. It will be appreciated, however, that anyinterlocking fastener 104 can be removed by rotating the interlockingfastener 104, such that the threaded shaft 108 of the interlockingfastener 104 moves relative to the ridges 178 of the corresponding boreof the movable member 160, while the securing device 200 remains in itslocked position relative to the intramedullary implant 102.

Referring to FIGS. 20-37, additional aspects of a fixation device 100according to the present teachings are illustrated. As illustrated,FIGS. 20-23 may particularly pertain to piriformis procedures, FIGS.24-32 may particularly pertain to trochanteric procedures, and FIGS.33-37 may particularly pertain to retrograde procedures. In thefollowing, similar elements are referenced with the same referencecharacters as those used in FIGS. 1-19B, and their correspondingdescription is not repeated. Additional or changed elements aredescribed with new reference characters.

Similarly to the fixation device 100 described in reference to FIGS.1-19B, the fixation device 100 illustrated in FIGS. 20-32 includes anintramedullary implant 102 and a securing device 700 received in theproximal longitudinal bore 113 of the intramedullary implant 102 forsecuring two reconstructive fasteners 140, as shown in FIG. 20A(piriformis procedure) and FIG. 24 (trochanteric procedure), or aninterlocking fastener 104, as shown in FIG. 23 (piriformis procedure)and FIG. 32 (trochanteric procedure). The securing device 700 caninclude a movable member or movable insert 760 and a locking member 780.

Similarly, the fixation device 100 illustrated in FIGS. 33-37 for aretrograde procedure can include an intramedullary implant 102 and asecuring device 900 received in the longitudinal bore 113 of theintramedullary implant 102 for securing four interlocking fasteners 104.The securing device 900 can include a movable insert 960 and a lockingmember 780. Various aspects of the securing devices 700 and 900 aredescribed below to the extent that they differ from the securing devices200 illustrated and described above in connection with FIGS. 1-19B. Thelocking member 780 of the securing devices 700 and 900 is similar to thelocking member 180 of the securing device 200, with elements designated7XX in locking member 780 corresponding to elements designed 1 XX in thelocking member 180, as shown in FIGS. 25, 35, 6A and 16, for example.

Similarly, the movable insert 760 of the securing device 700 is similarto the movable insert 160 of the securing device 200, with elementsdesignated 7XX in movable insert 760 corresponding to elements designed1XX in the movable insert 160, as shown in FIGS. 21, 25, and 5C, forexample.

The movable insert 760 of the securing device 700 can include first,second and third guiding bores 764, 766 and 768 similar to thecorresponding guiding bores 164, 166, 168 of the movable insert 200.Referring to FIGS. 20A, 21 and 22 for the piriformis procedure, and toFIGS. 24-31 for the trochanteric procedure, the movable insert 760 ofthe securing device 700 can include engagement formations in the form offirst and second pairs of elongated locking tabs or strips 800. Thelocking strips 800 are flexible and deformable and allow retention ofreconstructive fasteners 140 over a range of tolerance conditions. Thefirst and second pairs of flexible strips 800 can be formed on opposingsides of the walls of the corresponding first and second guiding bores764, 766, which can receive and guide the reconstructive fasteners 140in reconstructive procedures. The flexible strips 800 can engage thesubstantially smooth and unthreaded outer surfaces of the cylindricalsleeves 144 of the reconstructive fasteners 140 along the orientationsC, C′, as shown in FIGS. 20A and 24. Engagement formations in the formof substantially rigid threads or ridges 778, similar to ridges 178 ofthe securing device 200 described above, are provided for engaging thethreaded shaft 108 of the interlocking fastener 104 in the third guidingbore 768 along the axis B as shown in FIGS. 23 and 32, innon-reconstructive procedures or when reconstructive fasteners are notused.

Referring to FIGS. 33A-37, the movable insert 960 of the securing device900 for the retrograde procedure can include first, second, third andfourth guiding bores 904 a, 904 b, 904 c and 904 d along correspondingaxes D1, D2, D3 and D4 as shown in FIGS. 33A, and 34, for example. Theaxes D1 to D4 can be oriented at different three-dimensionalorientations relative to the longitudinal axes A, A1 of intramedullaryimplant 102 and the movable insert 960. Further, each interlockingfastener 104 can be oriented at a different angle relative to the otherinterlocking fasteners 104, as shown in FIG. 33A.

As it will be appreciated from the above description and drawings, thepresent teachings provide a securing device for intramedullary implantfixation that can be used telescopically to lock the intramedullaryimplant with more than one bone fasteners in interlocking orreconstructive procedures for the femur and tibia. Further, activecompression of a fracture site can be obtained with the same securingdevice. Although a few representative applications have been describedin detail, it will be understood that the present teachings can beapplied to other intramedullary fixation procedures and that featuresand elements of the fixation device described in connection with oneembodiment or procedure can be selectively combined with and/or replacefeatures described in connection with another embodiment or procedure.

The foregoing discussion discloses and describes merely exemplaryarrangements of the present invention. One skilled in the art willreadily recognize from such discussion, and from the accompanyingdrawings and claims, that various changes, modifications and variationscan be made therein without departing from the spirit and scope of theinvention as defined in the following claims.

What is claimed is:
 1. An orthopedic device comprising: anintramedullary implant defining a longitudinal bore; first and secondfasteners, each fastener including a threaded shaft and a substantiallycylindrical unthreaded sleeve; a cannulated movable member receivablewithin the longitudinal bore and telescopically movable relative to thelongitudinal bore, the movable member defining first and second guidingbores for respectively receiving the first and second fasteners, each ofthe first and second guiding bores at an angle relative to thelongitudinal bore, each of the first and second guiding bores includinga pair of opposing deformable elongated strips formed on walls of eachof the first and second guiding bores of the movable member andengageable with the respective unthreaded sleeve, the movable membermovable between a fastener engagement position and a fastenerdisengagement position, wherein the first guiding bore extends along afirst axis, and the pair of opposing deformable elongated strips formedon the wall of the first guiding bore extend in a directionsubstantially parallel to the first axis.
 2. The orthopedic device ofclaim 1, further comprising a third fastener having a threaded portion,and wherein the movable member includes a third guiding bore, the thirdguiding bore including threads engageable with the threaded portion ofthe third fastener.
 3. The orthopedic device of claim 2, furthercomprising a locking member threadably engageable to the longitudinalbore and couplable to the movable member, such that rotation the lockingmember telescopically moves the movable member within the longitudinalbore.
 4. The orthopedic device of claim 3, wherein the locking memberincludes a resilient portion defining a flange engaging an internalgroove of the movable member.
 5. The orthopedic device of claim 4,wherein the locking member includes a thread-interrupting opening and athread lock receivable in the opening.
 6. The orthopedic device of claim2, wherein the second guiding bore extends along a second axissubstantially parallel to the first axis and the third guiding boreextends along a third axis that intersects the first and second axes. 7.The orthopedic device of claim 6, wherein the second guiding bore isdefined by a first opening, the third guiding bore is defined by asecond opening, and the second opening is in communication with thefirst opening.
 8. The orthopedic device of claim 1, wherein the movablemember includes a proximal outer surface having an elongatedcross-section and mateably receivable within a proximal inner surface ofthe longitudinal bore.
 9. The orthopedic device of claim 8, wherein theelongated cross-section is substantially elliptical.
 10. The orthopedicdevice of claim 1, wherein the intramedullary implant includes anelongated compression slot for a corresponding bone fastener and one ofthe guiding bores is aligned with the compression slot, such that themovable member can be selectively moved between positions that allow ordisallow movement of the fastener relative to the compression slot. 11.The orthopedic device of claim 1, further comprising a locking memberthreadably engageable with the longitudinal bore of the intramedullaryimplant and non-threadably received into the movable member such thatrotation of the locking member telescopically moves the movable memberwithin the longitudinal bore of the intramedullary implant.
 12. Anorthopedic device comprising: an intramedullary implant defining alongitudinal bore; first and second fasteners, each of the first andsecond fasteners including a threaded shaft telescopically received in acorresponding substantially cylindrical unthreaded sleeve; a thirdfastener including a threaded shaft; a cannulated movable memberreceivable within the longitudinal bore and telescopically movablerelative to the longitudinal bore, the movable member defining first,second and third guiding bores for selectively receiving respectivelythe first, second and third fasteners, the first and second guidingbores extending along axes substantially parallel to each other, thethird guiding bore extending along an axis intersecting the axes of thefirst guiding bore and second guiding bore, the second guiding boredefined by a first opening and the third guiding bore defined by asecond opening, the second opening in communication with the firstopening, the first, second and third guiding bores oriented at variableangles relative to the longitudinal bore, each of the first and secondguiding bores including a pair of opposing deformable elongated stripsformed on walls of each of the first and second guiding bores andengageable with the respective unthreaded sleeve, the third guiding boreincluding a threaded formation engageable with the threaded shaft of thethird fastener, the movable member movable between a fastener engagementposition and a fastener disengagement position, the pair of opposingdeformable elongated strips of the first guiding bore extending in adirection substantially parallel to the axis of the first guiding bore;and a locking member threadably engageable with the longitudinal bore ofthe intramedullary implant and non-threadably received into the movablemember such that rotation of the locking member telescopically moves themovable member within the longitudinal bore of the intramedullaryimplant.
 13. The orthopedic device of claim 12, wherein the lockingmember includes a resilient portion non-rotatably couplable to themovable member.
 14. The orthopedic device of claim 13, wherein thelocking member includes a threaded portion threadably couplable to aproximal portion of the longitudinal bore of the intramedullary implant.15. The orthopedic device of claim 14, wherein the locking memberincludes a thread-interrupting opening and a thread lock receivable inthe opening.
 16. The orthopedic device of claim 12, wherein the movablemember includes a proximal outer surface having an elongatedcross-section and mateably receivable within a proximal inner surface ofthe longitudinal bore.
 17. The orthopedic device of claim 12, whereinthe third guiding bore of the movable member intersects the first andsecond guiding bores of the movable member.
 18. The orthopedic device ofclaim 12, wherein the intramedullary implant includes an elongatedcompression slot aligned with one of the guiding bores.
 19. Theorthopedic device of claim 12, wherein the first and second guidingbores of the movable member are substantially parallel.